Request Medical Records

All patient health care information at UTMB is confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law).

Written Authorization

Requests for the release of medical records (protected health information) must be submitted in writing and must contain all
the elements required by law. Authorizations must also be dated and signed by the patient or the patient’s legally authorized representative. In the case of a minor, a parent or legal guardian must sign the authorization.

UTMB has authorization forms that can be downloaded.

For patients/parent or guardian needing records, please submit the following form: English and Spanish (forms 7033/7033SP)

For all other requests for records please submit the following form: English and Spanish (forms 7032/7032SP)

These forms are designed for printing and are offered in Adobe Portable Document Format (PDF). If you do not have the software to view and print this type of document, you can download the plug-in for free from the Adobe Web Site.

Or you may contact the Health Information Management (HIM) Department at (409) 772-1965 and HIM will email or fax the authorization form to you.

If you reside in Brazoria County and need copies of records, please contact our UTMB Angleton Danbury Campus at (979) 848-9140 or you may fax your request for records to (979) 849-2912.

Submitting An Authorization

Completed authorization forms may be submitted to UTMB by mail or fax.

Processing Fees

A current fee schedule for disclosure of health care information is available on the UTMB Health Information Management Web Site, General Information tab.

No fee is assessed when the information is being sent to another health care provider or is for a social security disability
claim. Requests for medical record information for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.

For More Information:

For further information about the release of medical information, contact the UTMB Health Information Management Department
at (409) 772-1965.